MEDICARE: MARIA BENCY VENGACHUVATTIL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		MI

General Provider Information

NPI Number	:	1952175796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA BENCY VENGACHUVATTIL

Provider Business Mailing Address
First Line	:	42463 CANNON DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-2616
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5745 W MAPLE RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4468
Country	:	US
Telephone Number	:	248-862-5110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	10/18/2024

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